The predictive accuracy of cardiovascular disease risk prediction tools in inflammatory arthritis and psoriasis: an observational validation study using the Clinical Practice Research Datalink

David M Hughes*, Jose Ignacio Cuitun Coronado, Pieta Schofield, Zenas Z N Yiu, Sizheng Steven Zhao

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objectives
Cardiovascular risk prediction tools developed for the general population often underperform for individuals with RA, and their predictive accuracy are unclear for other inflammatory conditions that also have increased cardiovascular risk. We investigated the performance of QRISK-3, the Framingham Risk Score (FRS) and the Reynolds Risk Score (RRS) in RA, psoriatic disease (PsA and psoriasis) and AS. We considered OA as a non-inflammatory comparator.

Methods
We utilized primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database to identify individuals with each condition and calculated 10-year cardiovascular risk using each prediction tool. The discrimination and calibration of each tool was assessed for each disease.

Results
The time-dependent area under the curve (AUC) for QRISK3 was 0.752 for RA (95% CI 0.734–0.777), 0.794 for AS (95% CI 0.764–0.812), 0.764 for PsA (95% CI 0.741–0.791), 0.815 for psoriasis (95% CI 0.789–0.835) and 0.698 for OA (95% CI 0.670–0.717), indicating reasonably good predictive performance. The AUCs for the FRS were similar, and slightly lower for the RRS. The FRS was reasonably well calibrated for each condition but underpredicted risk for patients with RA. The RRS tended to underpredict CVD risk, while QRISK3 overpredicted CVD risk, especially for the most high-risk individuals.

Conclusion
CVD risk for individuals with RA, AS and psoriatic disease was generally less accurately predicted using each of the three CVD risk prediction tools than the reported accuracies in the original publications. Individuals with OA also had less accurate predictions, suggesting inflammation is not the sole reason for underperformance. Disease-specific risk prediction tools may be required.
Original languageEnglish
JournalRheumatology
Early online date15 Nov 2023
DOIs
Publication statusE-pub ahead of print - 15 Nov 2023

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